External Ear Conditions (Wax)

Introduction

A famous otologist in the mid-nineteenth century classified all cases of deafness into two categories: that due to wax, which could be cured; and all the others which were incurable. Happily, we have come a long way since then, but removal of occluding wax from the ear canal can still be a very rewarding procedure.

What is Wax?

Wax is produced only in the outer half of the meatus and normally it migrates out of the ear along with the desquamating cells of the canal skin. However those who 'dig at' their ears tend to push it back in again until either the build up occludes the canal, or almost occluded canal becomes completely occluded when water, or ear drops, complete the closure. It is only when the canal is completely occluded that wax causes significant hearing loss, which can be very disturbing.

Management

The treatment is removal of the wax and usually this can be done by simple syringing, so long as there are no contraindications such as a known pre-existing perforation. This is best carried out by using water at body temperature, directing the flow along the posterior canal wall, not directly at the ear drum, and ensuring that the water pressure is not dangerously high. This procedure usually produces an immediately grateful patient.
If syringing is unsuccessful or if there is a pre-existing perforation, manual removal is requried. This is best done by visualization under a microscope and extration of the wax either with a hook or, if the wax is soft, a sucker.
It has to be acknowledged that many doctors use ear drops to soften wax or partially dissolve it before either syringing or manually removing it. In actual fact, this is almost never necessary.

Complications

Careless syringing or inexperienced probing of the ear canal can cause innumerable problems, ranging from a simple perforation to a dead ear. Most of these can be avoided. It is important to be aware of the dangers from the patient moving the head at an inappropriate time.